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Response to "Time of Observation in Xenobiotic Ingestion in Children: Is 6 Hours Too Long?"
Mohan, Sanjay; Trebach, Joshua; Su, Mark K
PMID: 35608531
ISSN: 1535-1815
CID: 5228122
Cookie monster: A case report of a pediatric ingestion of zinc phosphide [Case Report]
Allen, Robert; Furlano, Emma R; Su, Mark; Wiener, Sage W
BACKGROUND:Zinc phosphide is a highly toxic rodenticide that reacts with hydrochloric acid in the stomach to form phosphine gas. Ingestion of zinc phosphide can result in consequential toxicity even when ingested in small quantities. Clear guidelines are lacking on appropriate personal protective equipment for providers to avoid additional exposure. CASE PRESENTATION/METHODS:We present the case of a four-year-old boy who suffered mild gastrointestinal symptoms after an unintentional ingestion of zinc phosphide. After discussion with the regional Poison Control Center, providers wore powered air-purifying respirators in a negative pressure room and experienced no symptoms of phosphine exposure. The patient was discharged the next day after a complete recovery. CONCLUSIONS:Clinicians should be aware of the potential clinical ramifications to patients who ingest zinc phosphide and the potential risks of caring for such patients. To prevent additional exposure, providers should don appropriate personal protective equipment and contact HAZMAT (or local health department) to safely remove additional zinc phosphide.
PMID: 35527098
ISSN: 1532-8171
CID: 5214022
Biostatistics and Epidemiology for the Toxicologist: Measures of Central Tendency and Variability-Where Is the "Middle?" and What Is the "Spread?"
Mohan, Sanjay; Su, Mark K
PMID: 35639280
ISSN: 1937-6995
CID: 5229332
Biostatistics and Epidemiology for the Toxicologist: Rock the ROC Curve
Trebach, Joshua; Su, Mark K
PMID: 35119595
ISSN: 1937-6995
CID: 5153902
Two Cases of Acute Direct Oral Anticoagulant Overdose Without Adverse Effect
Ha, Catherine J; Harmouche, Elie; Howland, Mary Ann; Su, Mark K
We report 2 pediatric patients who had acute overdoses of the direct oral anticoagulants medications. Both patients were managed conservatively; neither required reversal agents or blood products nor had any major or minor bleeding events. With therapeutic usage of direct oral anticoagulants, routine coagulation studies typically are considered insufficient measures of anticoagulation and the preferred chromogenic anti-Factor Xa assay is recommended but not widely available. Using a routine hybrid heparin anti-Factor Xa assay, 1 patient demonstrated a strong linear correlation up to a serum rivaroxaban concentration of 940 ng/mL.
PMID: 35200221
ISSN: 1536-3678
CID: 5175132
Thromboelastography in the setting of acetaminophen-induced hepatotoxicity
Mohan, Sanjay; Koziatek, Christian; Swartz, Jordan; Howland, Mary Ann; Su, Mark K
BACKGROUND/UNASSIGNED:Severe acetaminophen (APAP) poisoning can result in fulminant hepatic failure and abnormal tests of coagulation. Although the international normalized ratio (INR) may be elevated, the actual hemostatic status of patients with APAP-induced hepatotoxicity is unknown. Few studies exist investigating the clinical use of thromboelastography (TEG) to evaluate the hemostatic status in the setting of APAP-induced hepatotoxicity. METHODS/UNASSIGNED:We performed a retrospective review of patients who were admitted for APAP toxicity and received TEG testing at a single transplant center. RESULTS/UNASSIGNED:Nine patients had detectable APAP concentrations and exhibited elevated aspartate and alanine aminotransferase activities. Seven had thrombocytopenia. TEG revealed a decreased median alpha angle and maximum amplitude but other values were within the normal reference range. DISCUSSION/UNASSIGNED:Based on our study of APAP-induced hepatotoxicity, TEG showed a decreased rate of fibrin formation and cross-linking, as well as reduced clot strength. These findings suggest that patients with APAP-induced hepatotoxicity and thrombocytopenia have a theoretically increased bleeding risk as demonstrated by both elevated INR and abnormal TEG values. However, these TEG findings are more likely related to thrombocytopenia rather than directly to APAP-induced hepatotoxicity. Further studies should be performed to elucidate the potential role of TEG in various stages of APAP-induced hepatotoxicity.
PMID: 35014913
ISSN: 1556-9519
CID: 5116742
Biostatistics and Epidemiology for the Toxicologist: Incidence and Prevalence
DiSalvo, Philip; Su, Mark K
PMID: 34642866
ISSN: 1937-6995
CID: 5045872
The Cents of the Dosage Cap in Patients Greater than 100 Kilograms Receiving N-Acetylcysteine for Acetaminophen Toxicity [Letter]
Baum, Regan A; Su, Mark K; Weant, Kyle A
PMID: 35006548
ISSN: 1937-6995
CID: 5118412
Comment on: clinical experience with titrating doses of digoxin antibodies in acute digoxin poisoning [Letter]
Mahonski, Sarah; Howland, Mary Ann; Su, Mark K
PMID: 34709957
ISSN: 1556-9519
CID: 5042652
Comparison of the EXtracorporeal TReatments In Poisoning (EXTRIP) and Paris criteria for neurotoxicity in lithium poisoned patients
DiSalvo, Philip C; Furlano, Emma; Su, Mark K; Gosselin, Sophie; Hoffman, Robert S
AIMS/OBJECTIVE:Two guidelines for haemodialysis in lithium poisoning, one from the Extracorporeal TReatments in Poisoning (EXTRIP) workgroup and a single centre retrospective one (Paris) differ. We compared outcomes in lithium poisoning based on these criteria with a primary outcome of worsening neurological symptoms in patients for whom EXTRIP and Paris criteria were discordant. METHODS:Poison centre data were queried for lithium poisoned patients for whom haemodialysis was either recommended or performed. Patients were categorized according to EXTRIP and Paris criteria and excluded if the peak lithium concentration was <1.2 mmol/L or if neurological follow-up was unavailable. Comparative analyses were only performed when both criteria could be assessed. RESULTS:In total, 219 patients were analysed. Paris criteria were met in 70 and EXTRIP criteria in 178. Forty two patients were excluded because Paris criteria could not be evaluated. When Paris and EXTRIP both supported haemodialysis, 50/57 (88%) of patients who received haemodialysis improved, as did all 3 who did not receive haemodialysis. When Paris and EXTRIP did not support haemodialysis, all nondialysed patients did well. Among the 86 patients for whom EXTRIP supported haemodialysis but Paris did not, 4/19 (21%) patients not dialysed deteriorated (P = .02; odds ratio = 8.7, 95% confidence interval = 1.5-51.8), 1 of whom died. All 8 patients for whom Paris criteria supported haemodialysis but EXTRIP did not were dialysed and improved. CONCLUSIONS:When the EXTRIP and Paris criteria are discordant, EXTRIP criteria outperforms the Paris criteria at identifying potentially ill patients who might benefit from haemodialysis.
PMID: 33710651
ISSN: 1365-2125
CID: 4809632